Effectiveness of a comprehensive support program for families with parental cancer (Family-SCOUT): results of a multicenter non-randomized controlled trial

BACKGROUND

Cancer patients with minor children but also their families suffer from significant psychological distress and comorbidity. Protective factors predicting successful coping are well known. Corresponding systematic interventions are rare and limited by access barriers. We developed a comprehensive family-centered intervention for cancer patients with at least one dependent minor.

PATIENTS AND METHODS

Family-SCOUT represents a multicentric, prospective, interventional, and controlled study for families with parental cancer and their minor children. In the intervention group (IG), all family members were addressed using a care and case management approach for nine months. Families in the control group (CG) received standard of care. Participating parents were asked to complete the Hospital-Anxiety-Depression-Scale (HADS) questionnaire at enrolment (T0) and after 9 months (T2). The primary outcome was a clinically relevant reduction of distress in at least one parent per family, measured as minimal important difference (MID) of ≥1.6 in the HADS total score. The percentage of families achieving MID is compared between the IG and CG by exact Fisher's test, followed by multivariate confounder analyses.

RESULTS

T0-questionnaire of at least one parent was available for 424 of 472 participating families, T2-questionnaire after 9 months was available for 331 families (IG n = 175, CG n = 156). At baseline, both parents showed high levels of distress (HADS total: sick parents IG: 18.7 ± 8.1; CG: 16.0 ± 7.2; healthy partners: IG: 19.1 ± 7.9; CG: 15.2 ± 7.7). The intervention was associated with a significant reduction in parental distress in the IG (MID 70.4% in at least one parent) compared with the CG (MID 55.8%; P = 0.008). Adjustment for group differences from specific confounders retained significance (P = 0.047). Bias from other confounders cannot be excluded.

CONCLUSIONS

Parental cancer leads to a high psychosocial burden in affected families. Significant distress reduction can be achieved through an optimized and structured care approach directed at the family level such as family-SCOUT.

Antibody responses after BNT162b2 vaccination in Japanese geriatric intermediate care facilities

Background

To evaluate antibody responses against the primary series of vaccination of severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2] vaccines in the staff and residents of Japanese geriatric intermediate care facilities.

Methods

All subjects (159 staff and 96 residents) received two doses of the BNT162b2 mRNA vaccine 3 weeks apart. Baseline data of subject were collected using a structured form. Serum samples were collected three times: before vaccination, 3 weeks after the first dose, and 4 weeks after the second dose, and anti-receptor binding domain of the spike protein of SARS-CoV-2 [anti-RBD] IgG was measured using two immunoassays.

Results

After the second dose, geometric mean titers [GMT] of anti-RBD with both the Abbott and Roche assay were significantly lower in residents than staff (2282 AU/mL vs. 8505 AU/mL, and 258 U/mL vs. 948 U/mL, respectively). Multivariate analysis of characteristics affecting antibody responses (≥1280 AU/mL for Abbott and > 210 U/mL for Roche) showed lower odds ratios [ORs] for older age (adjusted OR per 10 year increase [aOR] = 0.62, 95 % confidence interval [95 %CI]; 0.38-1.02), steroid usage (aOR = 0.09, 95 %CI; 0.01-0.60) and regular nonsteroidal anti-inflammatory drugs [NSAIDs] usage (aOR = 0.16, 95 %CI; 0.03-0.88).

Conclusions

Elderly people and steroid and NSAID users had lower antibody responses following the second vaccine dose.

Incidence and risk factors for norovirus-related diarrhea in Japanese geriatric intermediate care facilities: A prospective cohort study

AIM

The risk of developing infectious diarrhea among elderly residents at Japanese geriatric intermediate care facilities is unclear. We investigated the incidence rate and risk factors of norovirus-related diarrhea at such facilities.

METHODS

This prospective cohort study followed 1727 residents from November 2018 to April 2020 at 10 geriatric intermediate care facilities in Osaka, Japan regarding the occurrence of diarrhea. Resident data were collected from their medical records using structured forms at two to three of the following three time points: at recruitment, if they developed diarrhea, and when they left the facility. Residents who developed diarrhea were tested using rapid diagnostic tests for norovirus. Cox proportional hazard model was employed to hazard ratios (HRs) with 95% confidence intervals (CIs) to estimate the risk factors for norovirus-related diarrhea.

RESULTS

During the study period, 74 residents developed diarrhea, 13 of whom were norovirus positive. The incidence rate of norovirus-related diarrhea was 10.11 per 1000 person-years (95% CI: 4.61-15.61). In terms of risk factors, people with care-needs level 3 were at a higher risk for developing norovirus-related diarrhea (adjusted HR [aHR] = 7.35, 95% CI: 1.45-37.30). Residents with hypertension (aHR = 3.41, 95% CI: 1.05-11.04) or stroke (aHR = 8.84, 95% CI: 2.46-31.83), and those who walked with canes (aHR = 16.68, 95% CI: 1.35-206.52) also had a significantly higher risk for norovirus-related diarrhea.

CONCLUSIONS

Throughout the study period, the incidence of development of diarrhea was low. Care-needs level 3, stroke, hypertension and use of a cane were identified as risk factors for norovirus-related diarrhea in Japanese geriatric intermediate care facilities. Geriatr Gerontol Int 2023; 23: 179-187.

Search for Dark Photon Dark Matter in the Mass Range 74-110 μeV with a Cryogenic Millimeter-Wave Receiver

We search for the dark photon dark matter (DPDM) using a cryogenic millimeter-wave receiver. DPDM has a kinetic coupling with electromagnetic fields with a coupling constant of χ and is converted into ordinary photons at the surface of a metal plate. We search for signal of this conversion in the frequency range 18-26.5 GHz, which corresponds to the mass range 74-110  μeV/c^{2}. We observed no significant signal excess, allowing us to set an upper bound of χ<(0.3-2.0)×10^{-10} at 95% confidence level. This is the most stringent constraint to date and tighter than cosmological constraints. Improvements from previous studies are obtained by employing a cryogenic optical path and a fast spectrometer.

POS1349 IMMUNOGLOBULIN G4-RELATED KIDNEY DISEASE’S PREDISPOSITION TO CHRONIC RENAL DYSFUNCTION, COMPLICATIONS OF MALIGNANCY, AND MORTALITY: A LONG-TERM NATIONWIDE MULTICENTER STUDY IN JAPAN

Background

In immunoglobulin G4-related kidney disease (IgG4-RKD), persistent renal insufficiency may be observed despite the good initial response to glucocorticoids[1, 2]. However, its long-term prognosis in relation to renal function as well as malignancy and mortality has not been well clarified.

Objectives

To clarify the long-term renal prognosis, complications of malignancy, mortality, and factors related to those outcomes in IgG4-RKD.

Methods

We retrospectively reviewed the medical records of patients with IgG4-RKD diagnosed by the expert members of the IgG4-RKD working group in the Japanese Society of Nephrology. We investigated clinical, radiological, and histopathological features at baseline and course of renal function, complications of malignancy, and mortality during the long-term observation periods (median 71 months) in 75 patients. Using collected data, we calculated the crude incidence rates (IR) of chronic kidney disease (CKD) status, malignancy, and death. Cox regression analyses were performed to assess CKD-related factors. Additionally, we calculated the standardized incidence ratio (SIR) of malignancy and standardized mortality ratio (SMR) using national Japan statistics.

Results

Fifty-nine patients were male, and 16 were female (median age 70 years). At diagnosis, their median eGFR was 45.1 mL/min/1.73m2 (interquartile range [IQR] 28.6-69.9). Seventy-two patients (96%) were treated with prednisolone at a median initial dose of 30 (IQR 30-39) mg/day, leading to a reasonable initial improvement of renal function. The IR of CKD was 30.2/100 person-years, and 66.7% (50/75) of the patients showed CKD at the last visit. Age- and sex-adjusted Cox regression analyses indicated that lower eGFR (per 10 mL/min/1.73m2, hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.61-0.80), pre-existing hypertension (HR 2.39, 95% CI 1.32-4.34), and wider areas with inflammation (>50% vs. <10%, HR 2.55, 95% CI 1.07-6.08) or fibrosis (>50% vs. <5%, HR 2.84, 95% CI 1.18-6.85) in the biopsied renal specimens at treatment initiation had a significant impact on the time to CKD. Eight patients (10.7%) died during follow-up due to malignancy, severe infection, cerebral hemorrhage, or myocardial infarction. The crude mortality rate was 1.76/100 person-years, and a SMR calculated according to national Japan statistics was 0.97 (95% CI 0.42-1.90). On the other hand, 15 patients were diagnosed as having malignancies during follow-up. The IR of malignancy was 3.71/100 person-years, and the SIR of malignancy was 1.80 (95% CI 1.03-2.93).

Conclusion

This study suggests that pre-treated renal insufficiency and extensive renal inflammatory and fibrotic lesions are related to CKD under glucocorticoid therapy in IgG4-RKD. Similarly with the whole IgG4-related disease, IgG4-RKD may have an increased incidence of malignancy but a mortality rate equivalent to the age- and sex-matched Japanese population.

References

[1]Saeki T et al. The clinical course of patients with IgG4-related kidney disease. Kidney Int. 2013 Oct;84(4):826-33.

[2]Mizushima I et al. Factors related to renal cortical atrophy development after glucocorticoid therapy in IgG4-related kidney disease: a retrospective multicenter study. Arthritis Res Ther. 2016 Nov 25;18(1):273.

Disclosure of Interests

None declared

Generation of Highly Vibrationally Excited CO in Sequential Photodissociation of Iron Carbonyl Complexes

Ultraviolet photochemistry of iron pentacarbonyl, Fe(CO)₅, was investigated with resonantly enhanced multiphoton ionization (REMPI) spectroscopy and ion imaging. The REMPI spectrum of CO photofragments, generated by ultraviolet irradiation of Fe(CO)₅, showed the generation in the highly vibrationally excited states with v = 11-15. Analysis of the band intensities observed in the 213-235 nm region indicated that the high-v CO generation was maximized at around 220 nm. Generation yields of the coordinatively unsaturated intermediates, Fe(CO)_n=1-4, were measured as a function of the photolysis wavelength using a nonresonant detection scheme. The yield spectrum of FeCO was correlated with that of the high-v CO fragments, suggesting high-v CO generation in the photodissociation of FeCO. The density functional theory calculations of the excited states of FeCO showed an intense photoabsorption to the metal-centered state near 220 nm. The theoretical results were consistent with the interpretation of FeCO + hν → Fe + high-v CO, which was experimentally indicated. The momentum distribution obtained from the velocity distributions of Fe, Fe(CO)₄, and CO fragments further supported that Fe is the counter-product of the high-v CO fragment. The present results provided selective observation of the photochemistry of the unsaturated iron carbonyl complexes, which has not been well elucidated in laser-based experiments because of the uncontrollable sequential photodissociation producing mixed Fe(CO)_n intermediates.

674The incidence and risk factors of acute infectious diarrhea at Japanese geriatric intermediate care facilities

Background

Norovirus infection and Clostridioides difficile infection (CDI) are major causes of acute infectious diarrhea at medical facilities. “Geriatric intermediate care facilities” are a type of medical facility that tend to the daily life needs of elderly Japanese people. However, there is no research about norovirus- or CDI-related diarrhea at Japanese geriatric intermediate care facilities.

Methods

This prospective cohort study included 1445 residents at 10 geriatric intermediate care facilities in Osaka between November 2018 and October 2019. The study subjects were followed regarding the occurrence of acute infectious diarrhea and the results of rapid diagnostic tests for norovirus and CDI. We calculated incidence rates and hazard ratios (HR) with 95% confidential intervals (CI) to identify the risk factors of infectious diarrhea.

Results

Thirty-seven residents developed diarrhea during the observation period, although none of them was positive for norovirus or CDI. The total incidence rate was 1.21/10,000 person-days (95%CI: 0.82-1.60). Compared with residents aged 87-91 years, those aged ≤ 80 years had a significantly higher risk of diarrhea (HR = 3.85, 95%CI: 1.27-11.66). Moreover, residents with thyroid diseases had a significantly higher risk of diarrhea than those without thyroid disease (HR = 5.33, 95%CI: 2.32-12.25).

Conclusions

The incidence of acute infectious diarrhea is relatively low. However, residents who are &lt; 80 years old and those with thyroid diseases are more likely to develop diarrhea.

Key messages

We describe the situation of acute infectious diarrhea at Japanese geriatric intermediate care facilities

Studying and Utilizing Traditional Technologies: Microstructure and Formation Mechanism of ε-Fe2O3 on Traditional Japanese Bizen Stoneware

Traditional Japanese Bizen stoneware is produced by firing a specific type of green clay in a wood-fired kiln at approximately 1200 °C. During this process, single crystalline branched dendrite-like particles of Al-substituted ε-Fe₂O₃ (ε-Fe_1.7Al_0.3O₃) with widths and lengths of approximately 15 and 30 μm, respectively, are formed on the surface of the ceramic. Composite particles consisting of ε-Fe₂O₃ epitaxially connected to spinel structure compounds [comprising the Fe-substituted spinel (Mg,Fe)(Al,Fe)₂O₄ and γ-Fe₂O₃)] with lengths of approximately 3 μm are also generated. The present work clarified the crystallographic relationship between ε-Fe₂O₃ and the spinel structure compounds. In addition, brown-colored samples similar to Bizen pottery and with surface Al-substituted ε-Fe₂O₃ particles were prepared by heating clay with K₂CO₃ under a 10 vol % CO gas and 90 vol % Ar gas mixture using an electric furnace instead of a firewood kiln. Hence, a traditional method was adapted to achieve the industrial production of ε-Fe₂O₃ crystals.

Primary and Secondary Loss of CO and NO Ligands in the Ultraviolet Photodissociation of the Heteroleptic Co(CO)3NO Complex

The photodissociation dynamics of the heteroleptic Co(CO)₃NO complex were investigated in the metal-to-carbonyl (CO) ligand charge-transfer band to compare the reactivity of the CO and nitrosyl (NO) ligands. The final state distributions of both the CO and NO fragments were measured using resonance-enhanced multiphoton ionization (REMPI) spectroscopy and velocity-map ion-imaging. The primary CO photofragment was differentiated from the secondary fragments of the subsequent unimolecular decomposition of coordinatively unsaturated intermediates by comparing the momentum distributions. The internal energy of the Co(CO)₂NO intermediate was sufficiently high (≥348 kJ/mol) to be generated in the electronic excited state, indicating the occurrence of the primary CO elimination on an excited state. The NO fragments exhibited two velocity components. The analysis of the final state distributions suggested that the higher- and lower-kinetic-energy components originated from the direct primary elimination and sequential elimination, respectively. The direct photoelimination through a transiently bent ligand conformation was illustrated on the basis of a two-dimensional REMPI approach and time-dependent density functional theory calculations. The present results of both ligands demonstrate the correlation between elimination mechanisms and possible ligand conformations in the electronic excited state.

A Cross-sectional Survey of the Clinical Manifestations and Underlying Illness of Cough

AIM

The aim of this study was to identify factors affecting the final diagnosis of cough.

MATERIALS AND METHODS

This study recruited 463 consecutive patients who visited five Japanese general hospitals due to cough from October 2006 to September 2007. Of these, 418 patients (90%) who completed a questionnaire designed to acquire data regarding clinical manifestations of cough were included.

RESULTS

Most patients with bronchial asthma had cough with seasonal variation and wheezing. Patients with gastro esophageal reflux disease suffered from heartburn and cough without daily or seasonal variation. Cough associated with sinobronchial syndrome was only observed in females and was linked to increased sputum. Patients with whooping cough were bothered by cough interrupting sleep and talking. Patients with cardiogenic cough had exertional dyspnea.

CONCLUSION

The specific items on our questionnaire relating to patient characteristics, complications, and triggers of cough, represent useful tools for diagnosing the primary disease producing cough.

A Numerical Analysis Method of Impurity Precipitation on Mesh Wire of Cold Trap in Fast Breeder Reactor

A fast breeder reactor (FBR) is considered as the promising technology in terms of load reduction on the environment, because the FBR has capability to improve usage efficiency of uranium resources and can reduce high-level radioactive waste which needs to be managed for millions of years. A cold trap is one of the important components in the FBR to control the impurity concentration of the liquid sodium. For accurate evaluation of the cold trap performance, we have been proposing the three-dimensional (3D) numerical analysis method of the cold trap. In this method, the evaluation of the impurity precipitation phenomena on the surface of the mesh wire of the cold trap is the key. For this, the numerical analysis method which is based on the lattice kinetic scheme (LKS) has been proposed. In order to apply the LKS to the impurity precipitation simulation of the cold trap, two models (the low Reynolds number model and the impurity precipitation model) have been developed. In this paper, we focused on the validation of these models. To confirm the validity of the low Reynolds number model, the Chapman–Enskog analysis was applied to the low Reynolds number model. As a result, it has been theoretically confirmed that the low Reynolds number model can recover the correct macroscopic equations (incompressible Navier–Stokes equations) with small error. The low Reynolds number model was also validated by the numerical simulation of two-dimensional (2D) channel flow problem with the low Reynolds number conditions which correspond to the actual cold trap conditions. These results have confirmed that the error of the low Reynolds number model is ten times smaller than that of the original LKS. The validity of the impurity precipitation model was investigated by the comparison to the precipitation experiments. In this comparison, the mesh convergence study was also conducted. These results have confirmed that the proposed impurity precipitation model can simulate the impurity precipitation phenomena on the surface of the mesh wire. It has been also confirmed that the proposed impurity precipitation model can simulate the impurity precipitation phenomenon regardless of the cell size which were tested in this investigation.

Warm-, hot- and pain-related neural activities depending on baseline skin temperatures

BACKGROUND

This study investigated the characteristics of temperature-related evoked neural activities to baseline skin temperatures on target and adjacent sites using contact heat evoked potentials (CHEPs).

METHODS

Contact heat evoked potentials were recorded from 12 normal subjects during three stimuli: target temperatures for "warm", "hot" and "pain" were set at 41, 46 and 51 °C, respectively. The baseline temperature was separately set at 30, 35 and 40 °C under all conditions, and a heat pulse was delivered over the right forearm at 41 °C under the warm condition, at 46 °C under the hot condition and at 51 °C under the pain condition.

RESULTS

The N2-P2 amplitude was significantly larger at the 40 °C baseline than at the 30 and 35 °C baselines during the pain condition, whereas no significant differences were observed during the hot and warm conditions. In addition, the effects of an interference warm stimulation to adjacent sites were examined; however, no significant effects were observed.

CONCLUSIONS

These results suggest that the priming effects of temperature on CHEPs were only observed under the pain condition, indicating the specificity of thermal pain, as well as a difference in the neural mechanisms responsible for thermal noxious and innocuous processing in human brains.

SIGNIFICANCE

This study using CHEPs shows the importance of baseline and target skin temperatures to investigate the characteristics of temperature-related neural activities. This measure may contribute to understanding of warm-, hot-, and pain-related neural activities in human brains.

Normal Age-Related Alterations on Chest Radiography

To ascertain serial changes on chest radiography attributable to aging, 16 parameters and 4 pulmonary parenchymal manifestations were assessed at 2 intervals; namely, 18.5 and 10 years after initial radiography in healthy men (n = 51) and women (n = 149) (age range 41–82 years). The transverse cardiac diameter, cardiothoracic ratio, and aortic arch transverse diameter increased significantly in both sexes from the initial to the final examinations. Although several other factors changed significantly, these changes were relatively small and the individual variations large. Initially, 13% and finally, 27% of the subjects exhibited at least one of the selected pulmonary manifestations.

MR Imaging of Adult Glomerulocystic Kidney Disease

A 59-year-old man with hypertension and severe renal dysfunction was diagnosed as having adult glomerulocystic kidney disease. MR imaging of the kidney showed a diffuse reduction of the intensity of the renal cortex with a loss of normal cortico-medullary differentiation on T1-weighted images. Numerous small cortical cysts were also demonstrated. These MR findings complemented the results of the biopsy and were useful for making a definitive diagnosis.

Computed Tomography of Adrenal Metastases in Hepatocellular Carcinoma

Four patients with adrenal metastases from hepatocellular carcinoma (HCC) diagnosed with computed tomography are described. In three, the metastases showed a central area of low density due to tumor necrosis, irregular contrast enhancement, and a well-defined margin. They measured 8 cm or more in diameter. In one, the adrenal metastasis was at first a relatively small homogeneously solid mass, but later, when it grew larger, a central low density developed. Since the adrenal gland is the second most common site of metastasis from HCC at autopsy, a combination of an adrenal tumor and a liver tumor should suggest this possibility.

Efficacy of adding sodium alginate to omeprazole in patients with nonerosive reflux disease: a randomized clinical trial

Nonerosive reflux disease (NERD) is the most common form of gastroesophageal reflux disease. Patients with NERD have a lower response rate to proton pump inhibitors (PPIs) than patients with erosive esophagitis when gauged from relief of heartburn. Sodium alginate decreases the acidity of refluxate and protects the esophageal mucosa. However, whether the addition of sodium alginate to PPI therapy can improve NERD symptoms remains unknown. Accordingly, the aim of this study was to evaluate the efficacy of adding sodium alginate to basal PPI therapy for NERD. Patients who had experienced heartburn on at least 2 days per week during the 1-month period before entering the study and had no endoscopic mucosal breaks (grade M or N according to Hoshihara's modification of the Los Angeles classification) were randomized to one of two treatments for 4 weeks: omeprazole (20 mg once daily) plus sodium alginate (30 mL four times a day) (group A) or omeprazole (20 mg once daily) alone (group B). Eighty-seven patients were enrolled, and 76 patients were randomly assigned to group A (n = 36) or group B (n = 40). Complete resolution of heartburn for at least 7 consecutive days by the end of treatment was significantly more common in group A (56.7%) than in group B (25.7%). One patient from group A had mild drug-related diarrhea that was not clinically serious. In conclusion, omeprazole combined with sodium alginate was better than omeprazole alone in Japanese patients with NERD.

Spatial distribution of hexabromocyclododecanes (HBCDs), polybrominated diphenyl ethers (PBDEs) and organochlorines in bivalves from Japanese coastal waters

In order to elucidate the spatial distribution of brominated flame retardants (BFRs) in the Japanese coastal environment, hexabromocyclododecanes (HBCDs), polybrominated diphenyl ethers (PBDEs) and organochlorines (OCs: PCBs, DDTs, CHLs, HCHs, HCB) were determined in bivalves (oysters and mussels) collected from Japanese coastal waters. HBCDs and PBDEs were detected in all samples analyzed. Concentration ranges of HBCDs were 12-5200 ng g(-1) lipid wt., followed by PCBs (20-3100 ng g(-1))>PBDEs (3.1-86 ng g(-1) lipid wt.). The highest concentration of HBCDs was found in the Osaka region. This result indicates that HBCDs are ubiquitous and predominant compounds in bivalves from the Japanese coastal waters. Since no species differences between oysters and mussels were observed for the bioaccumulation properties of HBCDs and PBDEs, oysters could be utilized for BFR contamination monitoring worldwide as an alternative to mussels. Global comparisons between oysters and mussels showed that HBCD concentrations in Japan are among the highest levels reported from Asia and Europe. Estimated dietary exposures of HBCDs and PBDEs through seafood were 0.45-34 ng kg body weight(-1)d(-1), and 0.054-6.8 ng kg body weight(-1)d(-1), respectively. These exposure levels were more than 1000 times lower than the lowest observable effects or no observable adverse effects levels for HBCDs and PBDEs, respectively.